How early SBIRT adopters became SBIRT billing innovators in Hospital Settings
WARNING Medical billing and/or clinical acronyms might be used during this presentation.
A Little Foreshadowing SBIRT stands for screening, brief intervention, and referral to treatment. Visit OHSU Family Medicine Oregon SBIRT webpage at http://www.sbirtoregon.org/ Our SBIRT approach was centered in outpatient primary care then expanded to include hospitals services and emergency departments.
Presentation Outcomes Outcomes include: How SBIRT is imbedded and operates within clinical out-patient settings, community center clinics, ED/ER and hospital health systems. Business/billing practices to maintain successful SBIRT integration. Use of electronic record integration to secure billing efficiency/training. Making documentation/billing easier for your clinicians How billing practices and workflows can be implemented.
Presentation Outcomes SBIRT success recipe in all major healthcare settings: Partnership with business office Leadership. Gain a Clinician Champion. Focus on front-end training. Show clinicians incentives (patient/clinician) from training. Include Team Based Coordination with existing Medical Home or Hospital staff.
What is OHSU Family Medicine U.S. News & World Report ranks our department among the nation's best academic family medicine departments, and we're very proud of the programs that have led to this national reputation. In the last 40 years, we ve gone from a tiny two-doctor clinic to a nationally-ranked major department in the medical school. We are a true integrated primary care location with a hospital structure. Meaning if we can do it, so can you..
What is OHSU Family Medicine Today we have four clinics, three hospital services at OHSU Hospital, residency programs in Portland and in Klamath Falls We have more than 50 residents, a required third-year medical school clerkship and a faculty of 95 clinicians, educators, and researchers In addition, we have over 250 volunteer faculty located throughout Oregon Again if we can do it, so can you.
What is OHSU Family Medicine We have five Oregon State Tier 3 Primary Care Medical Homes. We have integrated our primary care medical home care teams into In-Patient teams. We are also a complex health organization with various ways of billing and performing services. Yes again, if we can do it, so can you.
Usual Approach to SBIRT
Usual Approach to SBIRT
New Medicare CPT Codes No co-insurance/deductible G0442 Fee $17.33 Work RVU.18 (in addition to E&M code) Screening for alcohol misuse in adults including pregnant women once per year (Compare to.18 for a Work RVU 99211) G0443 Fee $25.14 Work RVU.45 (in addition to E&M code) Up to four, 15 minute, brief face-to-face behavioral counseling interventions per year for individuals, including pregnant women, who screen positive for alcohol misuse (Compare to.48 for a Work RVU 99212)
Our Approach to SBIRT Let providers do what they do best, TREAT PATIENTS!! Create a system that maximizes your Electronical Medical Record (EMR) or Health Information Technology (HIT)
Our Approach to SBIRT Epic Smart Phrases Epic Smart Sets
If we code it wrong.
Payer Involvement/Advocacy 3 Medicare Intermediaries (Cahaba, NGS, Noridian) Worked with State Medicaid: Addiction and Mental health Division. Called our top 14 payers Regence Blue Cross (local + out-of-state), Aetna, Cigna- Greatwest, United healthcare, Pacificsource, Premera, Providence, Lifewise, ODS, Healthnet, Tricare, PHCS, and Humana.
Epic Smart-Set
Epic Smart-Set
OHSU FM Approach to SBIRT Create front-end training that will carry forward to successful back-end billing. See Demo: http://www.sbirtoregon.org/reimbursementclinician-notes.php
The Twist There are various other ways to bill for SBIRT: Current literature focused in a Primary Care Private Practice Model. Out-Patient: Provider Bases Billing Facility Billing Home HealthCare Residency Program Urgent Care Facility FQHC/RHC/TRIBAL/IMM In-Patient: ED/ER/Observation Hospital Admissions
Coding and Billing
http://www.youtube.com/watch?v=ym0g6bfbjuc
Full Screening
Full Screening Professional billing Full screen no intervention Bill with CPT code 99420 No WRVU: Discuss load custom Reimbursed by Medicaid at $7.23 Commercial $18-$25 Medicare $0
Annual screen
AUDIT
AUDIT
Clinician Out-Patient Focus SBIRT WRVU: Clinic Setting Code: 99408, Work RVU:.65 (in addition to E&M code) Clinician must spend at least 15 min (Compare to.97 for a Work RVU 99213) Code: 99409, Work RVU: 1.30 (in addition to E&M code) Clinician must spend at least 30 min (Compare to 1.42 for a Work RVU 99214) Code: 99420 no W/RVU paid at $7.23 - $18.00
Clinician In-Patient Focus SBIRT WRVU: Professional In-Patient Code: 99408, Work RVU:.65 (in addition to E&M code) Clinician must spend at least 15 min (Compare to a low-level 99231 for a work RVU of.76) Code: 99409, Work RVU: 1.30 (in addition to E&M code) Clinician must spend at least 30 min (Compare to a mid-level 99232 for a work RVU of 1.39) Code: 99420 no W/RVU paid at $7.23 - $18.00
Hospital In-Patient Focus SBIRT WRVU: Facility In-Patient Widely accepted method of using DRG s to increase or provided added reimbursement for in-patient substance or alcohol abuse services. Revenue can vary from $50 greater than $350 respectively.
OHSU Care Team Approach See Demonstration: Facility Billing
Facility Billing Staff Time Based on the physical time spent with a patient. Staff Intervention: Based on the number or type of staff interventions by nursing or ancillary staff. Resources Used: Based on points assigned to each staff intervention. Created by integration: Time, Intensity, and Staff type. Acuity Point Scoring: Complexity of decision making, patient severity, and point tally.
Sample Facility Billing Sheet
Sample Facility Billing Sheet
EMR Epic
EMR Epic
EMR Epic
EMR Epic
EMR Epic
EMR Epic
EMR Epic
OHSU Billing Epic Smart-Phrase/Smart-Set
OHSU FM SBIRT Documentation Purpose: facilitate and track SBIRT Tools built in EPIC, OCHIN/EPIC Also built in Meditech, and Centricity systems at first for three clinics EPIC has limited options for customization
Coding: Documentation for Billing Who can bill? DO; MD; PA; NP; RN; LPN: Some states reimburse non-physicians at 85% physician payment schedule. Ancillary staff, including health educators, behavioral health councilors, licensed clinical social workers, may perform SBIRT services under the supervision of a credentialed provider. The services should relate to a plan of care and will require billing under the supervising physician. Other screening tools eligible for 99420 include the AUDIT-C, ASSIST, CAGE- 4, TWEAK and T-ACE, DAST, CRAFT, DUDIT, and GAIN. Reimbursement rates vary depending on payer contracts.
99211 VS. Facility Billing Lets discuss who/how/when/should
OHSU FM SBIRT Documentation Billing Requirements: PAYER INTERACTION Imbed SBIRT billing logic with our OHSU Epic EHR/Practice Management System. Create documentation that flows with Clinicians responses. Focus on front-end training and use follow-up to teach clinicians/staff. Clinical Champion.
SBIRT Outlooks SBIRT services imbedded within clinics to hospital systems have been shown to improve patient healthy outcomes. Any Health facility can run a successful SBIRT program with the right preparation and ongoing dedication. Use of electronic record integration (Epic, Centricity, NextGen, MediTech) can secure billing efficiency/training. SBIRT respectively does not add extraneous overhead to implement and provides revenue.
Comments or Questions? Joseph Hurley OHSU Family Medicine Hurleyj@ohsu.edu Tel (503)-494-3427 Fax (503)-494-4496 50